Inspiratory Muscle Training to Improve Total Joint Arthroplasty Outcomes

吸气肌训练可改善全关节置换术的效果

基本信息

批准号：
10725952
负责人：
Barbara K Smith
金额：
$ 22.56万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10725952
关键词：
Academic Medical Centers Acceleration Acute Address Adult Age Anesthesia procedures Attenuated Biological Breathing Cardiac Surgery procedures Caring Chemosensitization Clinical Clinical Research Consent Controlled Study Coughing Data Day Surgery Destinations Deterioration Dyspnea Elderly Enrollment Evidence based treatment Exercise Exploratory/Developmental Grant Face Fiber Frequencies Future Generations Health Services Accessibility Hospitalization Hospitals Hour Impairment Individual Inpatients Inspiratory Capacity Knowledge Learning Length of Stay Lower Extremity Lung Lung diseases Mechanical ventilation Medical Medical center Methods Morbidity - disease rate Motor Muscle Muscle function Operative Surgical Procedures Outcome Patients Postoperative Complications Postoperative Period Preoperative Care Preparation Proteolysis Public Health Randomized Readiness Recovery Rehabilitation therapy Replacement Arthroplasty Research Resources Respiratory Diaphragm Respiratory Muscles Respiratory physiology Risk Risk Factors Schedule Shortness of Breath Smoker Supervision Testing Time Training Vital capacity Walking clinical practice comorbidity follow-up high reward high risk improved neural neuromuscular neuromuscular function neuromuscular plasticity novel patient population postoperative recovery prescription opioid preservation pressure pulmonary function recruit respiratory safety net sex socioeconomic disadvantage standard of care surgery outcome ultrasound ventilation

项目摘要

ABSTRACT Total joint arthroplasty (TJA) surgeries are among the most common elective surgeries in the US and projected to increase in frequency. Recent TJA clinical practices have effectively reduced post-operative hospital length of stay, yet despite improvements in the efficiency of TJA care, the effects of TJA surgical procedures on pulmonary and respiratory muscle function are less widely appreciated. Even during surgeries as short as TJA, the administration of anesthesia, neuromuscular inactivity, and mechanical ventilation acutely deteriorate pulmonary function and trigger rapid, significant proteolysis of the primary inspiratory muscle, the diaphragm. However, conventional TJA preoperative care does not conventionally address these issues. Older adults, smokers, and those with significant pre-existing lung disease, multiple medical comorbidities, or socioeconomic disadvantage face the greatest risk for declines in post-operative pulmonary and respiratory neuromuscular function. Most patients who utilize our urban safety-net academic medical center have at least one of these risk factors, which can interfere with acute rehabilitation, increase the risk for post-operative pulmonary complications, and extend hospital length of stay. Thus, we propose a clinical study of preoperative inspiratory muscle training (IMT) among individuals with increased risk for pulmonary post-operative complications. Preoperative IMT has been shown to counteract post-operative inspiratory weakness and reduce postoperative pulmonary complications following prolonged cardiac surgeries, but its potential benefits have not been investigated in shorter surgeries such as TJA, with expected brief post-operative hospitalizations. The central hypothesis of this project is that preoperative IMT is feasible and will improve respiratory strength, hasten the early postoperative respiratory recovery, and optimize functional mobility for hospital discharge. Adults scheduled for TJA with pre-existing respiratory muscle or lung impairment will be randomized to complete either: daily IMT in advance of surgery (dIMT), a single acute IMT session immediately before surgery (aIMT), or usual surgical standard of care (SOC). Follow-up testing on the day of surgery and during the acute post-operative hospitalization will identify the feasibility of IMT (Aim 1), distinguish IMT effects on inspiratory and cough strength, (Aim 2), and evaluate patient readiness for discharge (Aim 3). This high risk, proof-of-principle proposal will provide the first controlled evidence concerning disturbances in the regulatory functions of breathing following TJA. Our plan is that data generated from this study will form the basis for future mechanistic studies of IMT to restore breathing strength and further optimize early rehabilitation following TJA.

抽象的总关节置换术（TJA）手术是美国最常见的选修手术之一增加频率。最近的TJA临床实践有效地减少了术后医院长度尽管TJA护理效率提高了，但TJA手术程序对肺部的影响和呼吸道肌肉功能不太广泛。即使在手术中较短的TJA中，麻醉，神经肌肉不活跃和机械通气急性恶化功能和触发对主要灵感肌肉的快速，显着的蛋白水解，即diaphragm。然而，常规的TJA术前护理通常不会解决这些问题。老年人，吸烟者和那些患有明显的肺部疾病，多种医学合并症或社会经济劣势的人面临术后肺和呼吸神经肌肉功能下降的最大风险。最多利用我们的城市安全网络学术医学中心的患者至少有其中一个风险因素可以干扰急性康复，增加术后肺并发症的风险，并延伸住院时间。因此，我们提出了一项术前吸气肌肉训练（IMT）的临床研究肺部术后并发症风险增加的人。术前IMT已显示抵消术后的灵感弱点，并减少术后肺并发症长时间的心脏手术，但尚未在较短的手术中研究其潜在的好处 TJA，预计短暂的术后住院治疗。该项目的核心假设是术前IMT是可行的，将改善呼吸系统力量，加快术后呼吸道恢复的早期，并优化功能活动性医院出院。计划为TJA带有先前存在的呼吸肌或肺部障碍的成年人随机完成任意的：每天在手术前IMT（DIMT），立即进行一次急性IMT疗程手术前（AIMT）或通常的手术护理标准（SOC）。手术当天的后续测试在急性术后住院期间，将确定IMT的可行性（AIM 1），区分IMT效应关于灵感和咳嗽的力量（AIM 2），并评估患者出院的准备就绪（AIM 3）。这种高风险，原则证明将提供有关监管中的干扰的第一个受控证据 TJA之后的呼吸功能。我们的计划是，这项研究产生的数据将构成未来的基础 IMT恢复呼吸强度并进一步优化TJA后的早期康复。